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General NPI Number Information
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NPI Number | 1457587321
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Entity Type | Organization
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Legal Business Name | 1 GALAXY OF DIVINE CARING, INC.
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 13570 GROVE DR SUITE 211
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City | MAPLE GROVE
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State | MN
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Zip | 55311-4400
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Country | US
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Telephone | 763-463-9313
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Fax | 763-494-6709
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Provider Business Mailing Address
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Address Line | 13570 GROVE DR SUITE 211
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City | MAPLE GROVE
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State | MN
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Zip | 55311-4400
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Country | US
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Telephone | 763-463-9313
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Fax | 763-494-6709
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Authorized Official
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Title or Position | ODS
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Name | ALEXANDER O BASSEY-BLACK
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Credential |
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Telephone | 763-463-9313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 343527
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License Number State | MN
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